The Ministry of Agriculture, Animal Industry and Fisheries shares a role in executing essential nutrition actions. Those areas where the ministry of agriculture can contribute towards nutrition improvement are:
⦁ Promoting control of anaemia.
⦁ Promoting production and consumption of iron-rich foods.
⦁ Promoting production and consumption of vitamin A-rich foods.
⦁ Promoting consumption of iodized salt.
⦁ Promoting vitamin A supplementation.
⦁ Ensuring adequate intake of quality food for the household members.
⦁ Reduction of women workload in agriculture.
Therefore, consistent with these actions, the Ministry is concerned with nutrition for pregnant mothers, breastfeeding mothers and children below five years.
Nutrition necessory for pregnant women
It is necessary that a woman is well nourished before pregnancy so that by the time she conceives, the body has sufficient capacity to meet both her and the baby’s needs. A malnourished woman may fail to deliver baby alive or if she does, the baby is likely to be underweight (the normal range is 2.5–4.5 kg at birth). One of the leading causes of maternal death at childbirth is insufficient blood. During pregnancy women have high nutrient needs because they have to build foetus tissue, build reserves for breast milk and also cater for their own nutritional needs. On average women should gain 8–12 kg in the course of pregnancy. Pregnant women need to eat more food rather than decrease the intake.
⦁ Pregnant women need to consume balanced diet following the Food and Nutrition Handbook for Extension Workers 34 guidelines for selecting energy-giving foods, body-building foods and protective foods. Pregnant women especially need foods rich in iron and vitamin A in addition to the balanced diet. Iron needs are highly increased partly due to the need to build reserves for child up to six months after birth before initiating complementary food intake
⦁ Pregnant women need to take foods rich in calcium, e.g., milk and mukene (silver fish) partly to take care of the increased requirement for building the foetus skeletal structure.
⦁ Pregnant women have higher needs for nutrients generally and should take snacks in between meals.
In addition, pregnant women should be educated to strictly observe the following:
1. Take the required amounts of iron and folic acid supplements toprevent anaemia.
2. Sleep under an insecticide-treated mosquito net.
3. Visit the nearest health facility at least four (4) times for antenatal care. This will enable them access a number of services that prepare them to deliver a healthy baby.
4. Deliver in a healthy facility with the help of a skilled health worker.
5. Get deworming pills, IPT and tetanus vaccine from a health facility.
6. Avoid excessive workloads therefore community and family support mechanisms should be encouraged.
7. Pregnant women should limit intake of alcohol, cigarettes. These cause negative effects on the foetus.
8. Should strictly take drugs on advice of the health personnel as some of them are potentially harmful to the unborn child.
9. Avoid negative cultural practices that reduce the intake of nutritious foods or impact negatively on their health such as:
⦁ Not consuming chicken and eggs.
⦁ Pregnant women not defecating in toilets/pit latrines.
Nutrition that are beneficial for breastfeeding mothers
Nutritional requirements during breastfeeding are higher than during pregnancy because the mother has to produce enough milk to sustain a baby (bigger than the foetus) for the first six months and beyond. Breastfeeding women need to eat a wide variety of foods. Nutrition guidelines for pregnant women as well apply here but a lactating mother needs to eat much more; that is to say one extra meal (five meals in total). Breastfeeding mothers should also take a lot of fluids to cater for the high amounts of water used to make breast milk. They should avoid self-medication, smoking and alcohol to prevent intoxicating the baby.
Nutrition for children 0 to 6 months
Breastfeeding and complementary feeding behaviours are important predictors of infant and child nutrition, health and survival. Breast milk is the best food for babies and is all the baby needs up to six months of age. Children from birth to six months of age should be exclusively breastfed. If you introduce any food before six months you will potentially expose the baby to unsafe and poor quality meals. Exclusive breastfeeding refers to feeding a child on breast milk only for the first six months. Mothers are advised to breastfeed their babies as many times as the baby demands to be fed (at least 8 times a day, every 2–3 hours). This will help maintain milk production. Even when the child is ill, continue breast feeding.
Advantages of Breastfeeding
⦁ Nutritionally Balanced: Human milk is considered an ideal food for infants, providing optimal nutritional balance in forms that are easily digestible and readily usable by the baby.
⦁ Immunity Support: It contains antibodies and other immune substances that help develop the infant’s immune system, combat infections, and promote overall health. Colostrum, the yellowish milk produced in the first days after birth, is especially rich in these protective ingredients.
⦁ Perfect Temperature: Breast milk is naturally released at an optimal temperature for the baby, ensuring comfort during feeding.
⦁ Safety and Hygiene: There is no risk of contamination, as seen in formula preparation, making breastfeeding a safe option.
⦁ Cost-Effective: It is much cheaper than formula feeding and other alternatives, making it more affordable for most families.
⦁ Bonding: Breastfeeding naturally fosters attachment and creates an emotional bond between mother and infant, strengthening their relationship.
⦁ Natural Child Spacing: Lactation delays the return of menstruation, helping to space subsequent pregnancies.
⦁ Postpartum Recovery: It aids the mother by helping the uterus return to its normal size after childbirth.
⦁ Cognitive Development: Exclusive breastfeeding for the first six months is linked to enhanced mental and brain development in infants, providing a strong foundation for future learning and growth.
Complementary feeding practices
Weaning is the gradual introduction of food into the diet of the child. Alongside breast milk at the age of six months, beyond 6 months, breast milk alone is not enough to meet the child’s increased nutritional needs for proper growth and development. During weaning there are six principles to follow: meal frequency, amount, thickness, variety, active feeding and hygiene. This is commonly referred to as the FATVAH.
1. Frequency of meals refers to the number of meals eaten in a day. In order to meet the child’s body’s needs, for growth, development, and activity, we must feed them frequent meals, meaning 3 meals and 2 snacks each day.
2. Amount of foods refers to how much food is eaten at each meal. It is important to eat foods in the appropriate amounts, again to ensure that we are not getting too little or too much food. For example, the youngest child needs less while the eldest child needs more amount of food for each meal as shown on table 3.
3. Thickness of foods/consistency (not too thick as to have difficulty chewing or swallowing, not too watery). The thickness of foods/ consistency is an important factor to eating well, because if food is too thick, it might make it difficult to chew and swallow. However, if food is too watery, the energy value of the food is reduced.
4. Variety of different foods from each food group. In session 2 we learned about the food groups and their importance. We now know that each food serves the body differently (“GO”, “GLOW”, “GROW”),therefore it is important to have a variety of foods from each food group in order to eat well. Use fortified foods, when available; give vitamin/ mineral supplements when animal products, fortified foods, or micronutrient (vitamin A, Fe & Zn) rich foods are not readily available.
5. Actively feed and support is important, particularly for PLHIV. This is more than just feeding PLHIV (both adults and children), but involves a number of actions to support PLHIV to have access to food, grow foods, and prepare these foods.
6. Food Hygiene. Proper hygiene practices will prevent disease occurrences and hence ensure good child growth and development: washing hands before eating and handling foods, clean utensils and clean water. This is a very important factor needed for eating well. Good hygiene reduces the risk of diseases.
WATER, SANITATION AND HYGIENE
PRACTICES (WASH)
WASH practices help to prevent caregivers and other house hold members from contracting water-related diarrhoea diseases and associated food borne diseases. A healthier and stronger household is more economically viable and resilient in the face of nutritional challenges. WASH practices benefit everyone, and integrating these practices into nutrition care programs provides additional opportunities and resources to improve overall health outcomes.
Water access
⦁ Access to safe water is considered a basic human need and, in most countries, a basic human right.
⦁ For many people especially in rural communities, there is lack access to safe water.
⦁ The negative effects of lack of access to sufficient quantities of water, water of reasonable quality, basic sanitation and hygiene aremagnified for sick people including the malnourished clients.
⦁ The added burden of unsafe water affects not only the malnourished individual, but the entire family, increasing the risk of diarrhoea disease and lost productivity.
Hand washing
If done properly and at critical times, washing hands with soap or an abrasive substance such as is effective in preventing diarrhoea.
Food hygiene
Although statistics of food borne illnesses are scanty in Uganda, many people die as a result of diarrhoea disease cases. These are attributed to contaminated food or water, universal precautions apply to food handling like washing of raw fruits and vegetables.
Good practices to improve food hygiene
⦁ Wash hands thoroughly before handling, preparing and eating food.
⦁ Wash the knives, chopping boards and all surfaces thoroughly with clean water before and after use.
⦁ Prepare and serve food when hot or warm.
⦁ Always boil/reheat left over food thoroughly before eating. Cover well all the foods in the house away from flies and other pests.
⦁ Keep the kitchen very neat.
⦁ Keep cooked food away from contact with raw food.
⦁ Avoid eating mouldy or rotten food.
⦁ Avoid taking oil seeds whose skin has been cracked, e.g., groundnuts, soybeans.
⦁ Wash vegetables with plenty of water at least three times before cutting it.
⦁ Avoid taking raw or partially cooked foods of animal origin.
⦁ All food grains and seeds such as maize and groundnuts should be properly dried and stored in a dry place. Use clean stores for storing foods.
Gaining Weight During Pregnancy
The amount of weight you should gain depends on your health and your BMI before pregnancy. Recommendations for weight gain for women who are pregnant with twins are somewhat higher (see Table 17-3). Weight gain during pregnancy should be gradual. During your irst 12 weeks of pregnancy—the irst trimester—you may gain only 1–5 pounds or no weight at all. In your second and third trimesters, if you were a healthy weight before pregnancy, you should gain between ½ pound and 1 pound per week. The key to gradual weight gain is to slowly increase the number of calories you consume throughout your pregnancy. In the irst trimester, when weight gain is minimal, no extra calories usually are needed. In the second trimester, you need an extra 340 calories a day, and in the third trimester, about 450 extra calories a day. Keep in mind that these amounts are for women who were a normal weight before pregnancy. If you were overweight or obese, you may need fewer extra calories.
Lactose Intolerance
Women who have trouble digesting dairy products can get calcium from other foods, including seeds, nuts, and soy. Lactose-free milk, cheese, and other dairy products also are available in grocery stores. Talk with your health care provider if you are having trouble consuming the recommended 1,000 mg each day. You may be advised to take a calcium supplement.
Celiac Disease
Women who have celiac disease are unable to eat foods containing gluten, which is found in wheat, barley, and rye. There are many foods that are gluten free, so pregnant women with celiac disease can choose fruits, vegetables, meats, potatoes, poultry, and beans. There also are many gluten-free products sold in grocery and natural food stores or online.
Food Safety
Pregnant women can get food poisoning just like anyone else. However, food poisoning in a pregnant woman can cause serious problems for both her and her baby. Vomiting and diarrhea can cause your body to lose too much water and can disrupt your body’s chemical balance. Several types of bacteria can cause food poisoning. It’s important to contact your health care provider as soon as you have these signs and symptoms.
KEY MESSAGE
In addition to the balanced diet, ensure an organized, clean health environment at household and consumption of safe food for all household members.
